Provider Demographics
NPI:1316065311
Name:HOSPITAL TRAVELER
Entity type:Organization
Organization Name:HOSPITAL TRAVELER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-396-5263
Mailing Address - Street 1:PO BOX 72014
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-2014
Mailing Address - Country:US
Mailing Address - Phone:602-396-5263
Mailing Address - Fax:704-973-9636
Practice Address - Street 1:6221 AMED RD
Practice Address - Street 2:
Practice Address - City:BAHAMA
Practice Address - State:NC
Practice Address - Zip Code:27503-9704
Practice Address - Country:US
Practice Address - Phone:602-396-5263
Practice Address - Fax:704-973-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200376570 AMedicaid
AZ443144Medicaid
SCV06724Medicaid
OK200123710 AMedicaid
TN1509453Medicaid